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  • Aghaebrahim, Amin  (23)
  • Jadhav, Ashutosh P  (23)
  • 1
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    Pivotal trial of the Neuroform Atlas stent for treatment of posterior circulation aneurysms: one-year outcomes
    BMJ ; 2022
    In:  Journal of NeuroInterventional Surgery Vol. 14, No. 2 ( 2022-02), p. 143-148
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 14, No. 2 ( 2022-02), p. 143-148
    Abstract: Stent-assisted coiling of wide-necked intracranial aneurysms (IAs) using the Neuroform Atlas Stent System (Atlas) has shown promising results. Objective To present the primary efficacy and safety results of the ATLAS Investigational Device Exemption (IDE) trial in a cohort of patients with posterior circulation IAs. Methods The ATLAS trial is a prospective, multicenter, single-arm, open-label study of unruptured, wide-necked, IAs treated with the Atlas stent and adjunctive coiling. This study reports the results of patients with posterior circulation IAs. The primary efficacy endpoint was complete aneurysm occlusion (Raymond-Roy (RR) class I) on 12-month angiography, in the absence of re-treatment or parent artery stenosis 〉 50%. The primary safety endpoint was any major ipsilateral stroke or neurological death within 12 months. Adjudication of the primary endpoints was performed by an imaging core laboratory and a Clinical Events Committee. Results The ATLAS trial enrolled and treated 116 patients at 25 medical centers with unruptured, wide-necked, posterior circulation IAs (mean age 60.2±10.5 years, 81.0% (94/116) female). Stents were placed in all patients with 100% technical success rate. A total of 95/116 (81.9%) patients had complete angiographic follow-up at 12 months, of whom 81 (85.3%) had complete aneurysm occlusion (RR class I). The primary effectiveness outcome was achieved in 76.7% (95% CI 67.0% to 86.5%) of patients. Overall, major ipsilateral stroke and secondary persistent neurological deficit occurred in 4.3% (5/116) and 1.7% (2/116) of patients, respectively. Conclusions In the ATLAS IDE posterior circulation cohort, the Neuroform Atlas Stent System with adjunctive coiling demonstrated high rates of technical and safety performance. Trial registration number https://clinicaltrials.gov/ct2/show/NCT02340585 .
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2020-017115
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2506028-4
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  • 2
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    Abstract TMP1: Infarct Location And Volumes As Predictors Of Outcome After Endovascular Recanalization Of Basilar Artery Occlusion
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background and Purpose: Prognostic information after endovascular recanalization of basilar artery occlusion is important for guiding aggressiveness of subsequent care. While final infarct volumes have been shown to correlate with outcomes in anterior circulation strokes, no such relationship has been described in basilar artery occlusions. We sought to determine the relationship between the volume of final infarction, location of infarction and outcome of clinical course in patients treated with endovascular therapy for basilar artery occlusion at our institution. Methods: A retrospective review of our prospectively maintained endovascular stroke database identified 103 patients of which 59 patients underwent post treatment MRI. Automated software was used to measure infarct volume. Results: Patients included in the study had the following features: mean age 61, mean NIHSS 20, female 24%. Successful recanalization (TIMI 2/3) occurred in 53/59 patients (90%). Infarcts were divided into topographic regions (see Table). Good outcomes (mRS 0-2 at 3 months) were achieved in 32% of patients. 71% of patients with no brainstem infarct had a good outcome (p=0.03). 46% of patients with no thalamic infarct had a good outcome (p=0.049). In multivariate analysis, independent predictors of good outcomes were brainstem infarct volume (OR 0.25, 95% CI 0.11-0.61, p=0.002) and age (OR 0.84, CI 0.74-.91, p=0.0018). Patients with good outcomes had a mean brainstem infarct volume of 1.45 cc, while patients with poor outcomes had a mean brainstem infarct volume of 6 cc (p=0.002). Conclusions: Rate of good outcomes after recanalization of basilar artery occlusion is 32%. Presence and volume of brainstem infarct, presence of thalamic infarct and patient age are the strongest predictors of outcome. Further studies will address whether these parameters can be used prospectively in prognosticating outcomes after basilar artery occlusive disease.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.ATMP1
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Transcervical access in acute ischemic stroke
    BMJ ; 2014
    In:  Journal of NeuroInterventional Surgery Vol. 6, No. 9 ( 2014-11), p. 652-657
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 6, No. 9 ( 2014-11), p. 652-657
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2013-010971
    Language: English
    Publisher: BMJ
    Publication Date: 2014
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  • 4
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    Streamlining door to recanalization processes in endovascular stroke therapy
    BMJ ; 2017
    In:  Journal of NeuroInterventional Surgery Vol. 9, No. 4 ( 2017-04), p. 340-345
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 9, No. 4 ( 2017-04), p. 340-345
    Abstract: In acute stroke due to large vessel occlusion, faster reperfusion leads to better outcomes. We analyzed the effect of optimization steps aimed to reduce treatment delays at our center. Methods Consecutive patients with ischemic stroke treated with endovascular therapy were prospectively analyzed. We divided the patients into pre-optimization (20 April 2012 to 8 October 2013) and post-optimization (9 October 2013 to 29 July 2014) periods. The main interventions included: (1) continuous feedback; (2) standardized immediate emergency department attending to stroke attending communication with interventional team activation for all potential interventions; (3) pre-notification by the emergency medical service; (4) minimizing additional diagnostic testing; (5) direct transport to the CT scanner; (6) transport directly from the CT scanner to the angiography suite. The main metric used to measure improvement was door to groin puncture time (D2P). Results We included a total of 286 patients (178 pre-optimization, 108 post-optimization). There were no significant differences between major baseline characteristics between the groups with the exception of higher median CT Alberta Stroke Program Early CT Score in the pre-optimization group (p=0.01). Median D2P improved from 105 min pre-optimization to 67 min post-optimization (p=0.0002). Rates of good clinical outcomes (modified Rankin Scale 0–2 at 3 months) were similar in both groups, with a trend toward a better outcome in the post-optimization group in a subgroup analysis of patients with anterior circulation occlusion who received intravenous tissue plasminogen activator. Conclusions This pilot study demonstrates that D2P times can be significantly reduced with a standardized multidisciplinary approach. There was no significant difference in the rate of 3-month good outcome, which is most likely due to the small sample size and confounding baseline patient characteristics.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2016-012324
    Language: English
    Publisher: BMJ
    Publication Date: 2017
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  • 5
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    Outcomes after endovascular treatment for anterior circulation stroke presenting as wake-up strokes are not different than those with witnessed onset beyond 8 hours
    BMJ ; 2015
    In:  Journal of NeuroInterventional Surgery Vol. 7, No. 12 ( 2015-12), p. 875-880
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 7, No. 12 ( 2015-12), p. 875-880
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2014-011316
    Language: English
    Publisher: BMJ
    Publication Date: 2015
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  • 6
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    Abstract WP28: Safety and Feasibility of Angioplasty and Stenting in Symptomatic Internal Carotid Artery Occlusive Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Introduction: Symptomatic internal carotid artery occlusion (ICAO) can lead to subsequent neurologic decline, recurrent stroke, and mortality. We sought to evaluate safety and feasibility of endovascular revascularization for ICAO without tandem intracranial large vessel occlusion (LVO). Methods: This is a retrospective cohort analysis of all patients presenting to a single academic center with ischemic stroke and ipsilateral, cervical ICAO from November 2003 through April 2016. Patients were excluded if pre-procedural angiography demonstrated tandem LVO or if patients were known to have chronic ICAO. Study endpoints included discharge neurologic exam, post-procedural infarct burden, 3-month functional outcomes, and treatment durability. Results: A total of 107 patients with symptomatic, angiographically confirmed cervical ICAO without tandem LVO were identified. Median admission NIHSS was 8 (IQR 11). Baseline radiographic stroke severity was assessed by ASPECT score (median 9; IQR 2), perfusion mismatch (present in 93%), and clinical-diffusion mismatch (42%). Median time from symptom onset to treatment was 25 hours (IQR 61). Successful revascularization was achieved in 92% of patients. At discharge, 83% had stable or improved NIHSS, while at 3-months 65% achieved functional independence (mRS ≤2). The most common complication was distal embolization (22%) of which 16% required intra-arterial treatment. Rate of significant restenosis (≥70%) was 15% at 1-year. Conclusions: Stenting in selected patients at risk of neurological deterioration due to symptomatic ICAO can be performed with high rates of technical success and good clinical outcomes. Because of significant peri-procedural risks and high rates of restenosis, randomized studies are necessary to understand the benefit of this approach.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.WP28
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 7
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    Abstract TP6: Octogenerians Have High Rates Of Favorable Outcomes After Endovascular Therapy For Acute Stroke Due To M1 Occlusion If Final Infarct Volumes Are Small
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background and Purpose: Octogenerians have consistently been shown to have poor outcomes after endovascular therapy for acute stroke. On the other hand, final infarct volumes are predictive of outcomes. We sought to explore the relationship between final infarct volumes and outcomes in octogenerians with acute stroke due to M1 MCA occlusion treated with endovascular therapy at our institution. Methods: Retrospective analysis of an acute stroke endovascular database was performed. Inclusion criteria were acute M1 MCA occlusion and post procedural MRI allowing for final infarct volume analysis through an automated software application. Results: A total of 219 patients were identified of which 51 (23%) were 80 years or older. Median age in non-octogenerians was 65.5 versus 83 in octogenerians. Females were 51.8% versus 67%, respectively. Median admission NIHSS was 16 versus 17 (p=ns). Median final infarct volume was 43.6 cc vs. 43.3 cc (p=ns). Median time to treatment was 5.6 hours versus 5.5 hours. Successful recanalization rate (TIMI 2/3 flow) was achieved in 139/168 (83%) versus 45/51 (88%) (p=ns). Multivariate analysis, controlling for admission NIHSS score, recanalization and intubation and time from symptom onset to procedure, identified age (OR 0.9, p 〈 0.0001, 95% CI 0.86-0.93) and final infarct volume (OR 0.98, p 〈 0.0001, 95% CI 0.97-0.99) as predictors of favorable outcome (mRS 0-2 at 3 months). The rate of favorable outcomes was 89/168 (53%) versus 10/51 (19.6%) (p 〈 0.0001). Mean final infarct volume in non-octogenerians with good outcome was 40 cc versus 19 cc in octogenerians (p=0.014). In patients with less than 20 cc of final infarct volume, 84% (37 out of 44) of non-octogenerians had a favorable outcome versus 46% (6 out of 7) of octogenerians (p=0.01). Conclusions: Despite similar recanalization rates and final infarct volumes, outcomes after endovascular therapy for MCA occlusions in octogenerians are worse than in non-octogenerians. However, outcomes are strongly related to infarct volumes and consequently nearly half of octogenerians with final infarct volume of 〈 =20 cc had favorable outcomes. A small final infarct volume is best predicted by successful recanalization and high pre-procedural ASPECT scores (9 or 10).
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.ATP6
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 8
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    Abstract TP309: The Role of Teleconsultation in Acute Stroke Trial Enrollment
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: A major barrier to enrollment into acute stroke clinical trials is timely access to a tertiary care center conducting the study. Tertiary centers often receive the majority of their patients through broad referral networks. Remote consent via telephone, telemedicine or web-based technology are strategies that have been suggested to broaden enrollment. There is limited data on the feasibility and efficacy of those methods. Methods: There are 19 telemedicine sites and 23 non-telemedicine sites in our network. We describe our experience with screening and enrolling patients into acute stroke clinical trials via our referring network. Based on mode of presentation, we divided all patients enrolled in trials into 3 cohorts; direct presentation with no prior consultation, transfer after consultation by telephone only and transfer after full telemedicine consultation. We classified trials based on required timeframe of enrollment into urgent and non-urgent. We used two-way ANOVA to compare the differences between the three cohorts across both types of trials. Results: Between January 2013 and July 2015, 175 patients were enrolled into 13 clinical trials, 8 of which were urgent. Telephone consults resulted in the highest volume of enrollment (46.3%). Telemedicine consults resulted in higher enrollment into urgent vs non-urgent trials (18.6% vs 11%). Combined; telephone and telemedicine consults comprised the majority of enrollment volume (61.7%). The results were statistically significant (Urgency of Enrollment, p = 0.02. Type of Consult, p = 0.002). Conclusion: Tele-consultation is a feasible and efficacious resource for recruitment into acute stroke trials. Wide implementation of this method can achieve broader recruitment and more rapid completion of trials. Although no major protocol violations or delays were reported in our study, future trials can assess the reliability of the different methods.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.tp309
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 9
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    Abstract 144: The Pittsburgh Outcomes After Stroke Thrombectomy (POST) Score Predicts Good Outcomes After Endovascular Therapy for Anterior Circulation Large Vessel Occlusions
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. suppl_1 ( 2014-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. suppl_1 ( 2014-02)
    Abstract: Background: Independent predictors of good outcome following large vessel occlusions (LVO) include age, infarct volume, NIHSS at presentation and revascularization status. The aim of this study was to develop an easy-to-use tool to predict good outcome following endovascular treatment for LVO. Methods: In a derivation cohort of patients with anterior circulation LVO treated with endovascular therapy at Grady Memorial Hospital (GMH, n=247), we performed logistic regression to identify independent predictors of good outcome (mRS 0-2 at 90 days). Factors were weighted based on B-coefficients to generate a score (POST) that predicts good outcome. The derivation cohort was divided in risk group quartiles and correlation analysis between predicted and observed rates of good outcomes was performed. POST was also validated in two cohorts derived from the University of Pittsburgh Medical Center (UPMC, n=380) and the DEFUSE 2 database (n=105). Results: In the derivation cohort (mean age 66±1 yrs, median NIHSS 18), independent predictors (p 〈 0.2) of good outcome included final infarct volume (FIV; OR 0.97, 0.96-0.98), age (OR 0.96, 0.94-0.98), NIHSS at presentation (OR 0.93, 0.88-0.98) and PH1/PH2 hemorrhage (H; OR 0.3, 0.06-1.6, p=0.15). POST was defined as Age + 0.5 X FIV + 15 X H. Patients in the lowest POST quartile ( 〈 60) had a 91% chance of good outcome as compared to 3% in the highest POST quartile (≥120). There was a strong correlation between predicted and observed rates of good outcomes in the 4 groups (R=0.99, p 〈 .001). POST performed well in predicting good outcomes in the derivation (AUC=0.85), as well as the UPMC (AUC=0.81) and DEFUSE 2 (AUC=0.86) validation cohorts. Discussion: The POST score is a validated tool to predict good clinical outcomes following endovascular therapy in patients with acute large vessel occlusions. This tool can guide families and physicians in clinical decision making following endovascular therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.45.suppl_1.144
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 10
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    Abstract TP11: Treatment Times and Outcomes With Utilization of Telemedicine Prior to Transfer for Stroke Endovascular Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: Reducing time to treatment is important for acute stroke therapy including intravenous tPA and endovascular therapy. Remote evaluation of acute stroke patients by telemedicine may help triage patients for endovascular therapy and facilitate earlier treatment. Purpose: We aimed to evaluate efficiency and clinical outcome using telemedicine as a screening tool prior to transfer of stroke patients to comprehensive stroke centers for endovascular therapy. Methods: We retrospective reviewed patients receiving endovascular therapy at the University of Pittsburgh Medical Center from January 2014 through May 2015 who were initially evaluated for acute stroke at an outside facility and transferred to our hospital. We statistically analyzed our data using unpaired T test with equal standard deviation. Results: 116 patients treated with endovascular therapy were identified. 35 (30.1%) had telemedicine (TM) evaluations prior to transfer and 81 (69.8%) were transferred without telemedicine screening (NTM). The average age was 68 years in TM group and 67 years in NTM group. 71% of TM patients received IV TPA compared to 30% of NTM patients. The average NIHSS on arrival was 17 among TM and 16 in NTM. The mean time from door to groin puncture was 54 minutes in TM patients compared to 66 minutes in NTM group (p=0.37). Good outcomes (mRS 〈 2) occurred in 54% of TM cases and 36% of the NTM group (p=0.12). Poor outcomes (mRS 5-6) were 21% in TM patients and 40% in the NTM group (p=0.08). TICI 2b/3 revascularization was achieved in 88.5% and 88.9% in TM and NTM groups respectively (p=0.2). Conclusion: Evaluating acute stroke patients using telemedicine prior to transfer to comprehensive stroke centers may reduce time to intervention and improve selection of patients more likely to benefit from endovascular therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.tp11
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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